Q&A: Experts ‘distressed’ about COVID-19’s impact on immigrants
The COVID-19 pandemic has disproportionately affected immigrants in the United States, and the disease causing even more difficulty for this population to access quality health care, according to the authors of a JAMA Internal Medicine paper.
Chanelle Diaz, MD, MPH, and colleagues at the Albert Einstein College of Medicine and Montefiore Health System said they were “distressed” by the effect of the pandemic in the low-income borough of the Bronx in New York City, “one of the most ethnically diverse urban areas in the U.S.” Often, patients must face their illness alone in the hospital without family members who often serve as “cultural mediators between them and the health system,” they wrote. Additionally, communication is hampered not only by language barriers but also personal protective equipment.
“Trying to communicate with anyone while speaking through an N95 mask, plastic face shield, and full personal protective equipment is difficult; to do so via a telephone interpreter with a patient who is short of breath and speaks a different language feels particularly depersonalizing and inadequate,” they wrote.
Moreover, patients have difficulty following post-discharge plans because outpatient practices are closed — this is especially problematic for undocumented immigrants who already have a difficult time navigating the health system, the authors said.
Healio Primary Care spoke with Diaz about the barriers facing immigrants in the health system and how community health workers and physicians can help. – by Janel Miller
Q: What evidence is there to suggest that low-income immigrants are disproportionately affected by COVID-19?
A: Like many urban areas in the United States, New York City is very segregated. Immigration status is not — and should not be — routinely collected or reported in health care settings. Current immigration enforcement policies and fear of deportation and/or stigma suggest if such information were asked, immigrants would avoid needed care. Unfortunately, this means we do not have any direct or patient-level data to know how COVID-19 is impacting immigrants.
For example, we can get a good picture of how COVID-19 impacts low-income immigrants by looking at who lives in each of the five boroughs of New York City. Previously published data show that 56% of the borough’s residents identify as Hispanic/Latinx, and almost 60% speak a language other than English at home. The Bronx also has the lowest median household income among the five boroughs — $38,000 annually — and the highest proportion of people living in poverty — 27.3%. New York City has been tracking COVID-19 hospitalizations and deaths along socioeconomic and racial/ethnic lines. These data show that among the five boroughs, the Bronx has the highest proportion of hospitalizations and deaths related to COVID-19. An analysis by the Migration Policy Institute found that 13 of the 20 U.S. counties with the most cases per capita as of April 14th have higher concentrations of noncitizens than the national average.
Q: What other parts of the country might be seeing similar trends?
A: Racial and ethnic disparities among COVID-19 patients is a national trend and, frankly, a national disgrace. Recent CDC data indicated that, in the United States, death rates from COVID-19 were 50% to 100% higher for black and Latino persons vs. white persons. An analysis by the Migration Policy Institute found that 13 of the 20 U.S. counties with the most cases of COVID-19 per capita as of April 14th have higher concentrations of noncitizens than the national average.
These data are not limited to major cities. Six million immigrant workers are staffing essential industries where exposure to COVID-19 can be high, without adequate protections. Moore County, North Carolina, currently has the fastest growing COVID-19 outbreak in the country. The area is home to a beef processing facility. At a Smithfield Foods meat plant in South Dakota where 40 languages are spoken, 783 workers tested positive for COVID-19, demonstrating how working conditions at these plants are placing immigrants at higher risk; workers reported overcrowding, insufficient personal protective equipment, lack of testing and tracing, and being discouraged from calling out sick. These concerns are not unique to one plant or industry, and illustrate how working conditions can put immigrants at increased risk.
Q: What is the role of community health workers in this pandemic? How can they help remove barriers to care for immigrants?
A: Community health workers have a critical role to play. Since they are often from the communities they serve, they seamlessly navigate cultural and language barriers. Community health workers can link high-risk individuals to a health system; identify unmet social needs; disseminate reliable information; ensure immigrant communities are receiving important public health messaging; inform the community about health-related resources; and ensure that immigrants’ voices are heard when institutions and governments implement policies related to COVID-19.
Q: How can primary care providers integrate community health workers into their practice?
A: At my health system, community health workers work closely with social workers and health care providers to reach out to patients from vulnerable communities. Before the pandemic, and still now, community health workers are tirelessly reaching out to our health system’s patients who have unmet social needs, such as unstable housing and food and economic insecurity. This connection has allowed health care providers to better appreciate some of the factors affecting patients’ health and link them to community-based resources to meet their unique needs.
CDC. COVID-19 in racial and ethnic minority groups. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/racial-ethnic-minorities.html. Accessed May 12, 2020.
Migration Policy Institute. Vulnerable to COVID-19 and in frontline jobs, immigrants are mostly shut out of U.S. relief. https://www.migrationpolicy.org/article/covid19-immigrants-shut-out-federal-relief. Accessed May 18, 2020.
Migration Policy Institute. Immigrant workers: Vital to the U.S. COVID-19 response, disproportionately vulnerable. https://www.migrationpolicy.org/research/immigrant-workers-us-covid-19-response. Accessed May 18, 2020.
Molteni M. Why meatpacking plants have become COVID-19 hot spots. Wired. May 7, 2020. https://www.wired.com/story/why-meatpacking-plants-have-become-covid-19-hot-spots/. Accessed May 12, 2020.
Siemaszko C. Language barriers helped turn Smithfield Foods meat plant into COVID-19 hotspot. NBC News. April 23, 2020. https://www.nbcnews.com/news/us-news/language-barriers-helped-turn-smithfield-foods-meat-plant-covid-19-n1190736. Accessed May 12, 2020.
Disclosures: Diaz reports no relevant financial disclosures. Please see paper for all other authors’ relevant financial disclosures.